Living with Bariatric Surgery: Managing your mind and your weight

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You’ve tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off. European Coalition of People living with Obesity (ECPO)– works collaboratively across Europe to improve the lives of people who are living with obesity through advocacy, policy and education. any risk factors assessed using lipid profile (preferably done when fasting), blood pressure measurement and HbA1c measurement Get authorization from your insurance provider: This is to make sure your insurance will cover some or all of the cost of surgery.

Bariatric surgery impacts nutritional intake and after surgery specific dietary changes are recommended, including – small portions, more frequent meals, adequate protein intake, and the addition of daily multivitamin and mineral supplements ( O’Kane, Bettini, Busetto). comorbidities (such as hypertension, hyperinsulinaemia, dyslipidaemia, type 2 diabetes, psychosocial dysfunction and exacerbation of conditions such as asthma) Dr Ratcliffe explained that many patients do not ‘update’ their body image after surgery, so they look in the mirror and see themselves as the same size that they were before surgery. It can take the brain some time to catch up and she encourages patients to gather accurate information such as taking photos, paying attention to their new clothes size and noticing things they are physically able to do that were previously not possible. Gastric bypass may result in the most significant weight loss when compared to other bariatric surgeries. But it’s also the most complex of all the types of bariatric procedures.

Clinical trials

There is also a perception that bariatric surgery is somehow the ‘easy option’– so some patients feel guilty or ashamed because they feel they are taking the easy route by having surgery – when actually they are choosing the most evidence-based treatment available.” Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than do most other procedures. Bariatric surgery is done in the hospital using general anesthesia. This means you're unconscious during the procedure. The goal of a duodenal switch is to reduce calorie intake and lead to more rapid weight loss. But this type of bariatric surgery also involves the most risks. Your body may not be able to tolerate the band’s presence, leading to inflammation or other complications in the area where the band is placed. In these cases, a doctor will need to remove the gastric band. This is why gastric bypass or sleeve gastrectomy are often preferred over a gastric band, according to the NIDDK. Duodenal switch

Be careful to avoid stigmatising language or blaming the patient for weight regain. Some weight regain is expected due to powerful biological drivers even with good adherence to dietary advice. But it's a major operation and in most cases should only be considered after trying to lose weight through a healthy diet and exercise. NHS weight loss surgery you have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure) If you qualify for bariatric surgery, your health care team gives you instructions on how to prepare for your specific type of surgery. You may need to have lab tests and exams before surgery. You may have limits on eating and drinking and which medicines you can take. You may be required to start a physical activity program and to stop any tobacco use. Lorico S, Colton B. Medication management and pharmacokinetic changes after bariatric surgery. Can Fam Physician 2020;66:409-16.

After Surgery

Parikh M, Johnson JM, Ballem N; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS position statement on alcohol use before and after bariatric surgery. Surg Obes Relat Dis 2016;12:225-30.

All these operations can lead to significant weight loss within a few years, but each has advantages and disadvantages. In addition, she highlighted that often people avoid certain situations because of their weight, so after surgery they encounter new situations and relationships, and often they need support in how to form new relationships, as well as develop their confidence in new social situations, and quite often this will mean learning new skills.

Types

Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen the desire to eat. Coulman KD, et al. (2020). Patients’ experiences of life after bariatric surgery and follow-up care: A qualitative study. Bariatric surgery isn't for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify. You also must be willing to make permanent changes to lead a healthier lifestyle. Moreover, she stressed that it is important that patients think about actively managing mood issues, such as depression and anxiety, either before or alongside surgery. These are not necessarily factors which should prevent people from having surgery, she added, but it is vital that patients are aware so they are able to anticipate, recognise and manage themselves after surgery. By identifying these issues and how they are linking to eating, healthcare professionals can then help patients develop strategies and coping mechanisms, so patients can manage their issues in a different way rather than defaulting to their usual patterns. Managing expectations There is a potentially serious risk of malnutrition if the patient receives inadequate follow up or is unable to adhere to the nutritional guidelines. Patients may be at risk of protein malnutrition, which can be caused by vomiting from an overtight gastric band, anastomotic stricture, chronic diarrhoea/malabsorption or insufficient dietary protein or nonadherence with dietary advice. The incidence of iron deficiency anaemia, vitamin D deficiency, B vitamins especially thiamine and B12 deficiency is increased following gastric bypass, sleeve gastrectomy and duodenal switch. Patients who undergo more malabsorptive operations such as a duodenal switch, single anastomosis duodenal ilieal bypass (SADI), or long limb gastric bypass are at additional risk of developing deficiencies in fat soluble vitamins and require long term specialist care. Most GPs are unable to request blood tests for fat soluble vitamins A, E and K or prescribe the appropriate supplements.

This reduces the size of your stomach to around 20% of its original size. You won’t be able to eat as much as you could before surgery and you’ll feel full sooner. Why treat obesity?

Oral contraceptives may not be reliable after bariatric surgery. This is due to lower absorption and bioavailability after gastric bypass and concerns about effectiveness following all types of bariatric surgery. 4, 9 Alternative contraceptive methods should be considered, in particular long-acting reversible contraception. Monitor for decreased efficacy. If efficacy is decreased, consider dose increase, change in formulation or route, or alternative drugs for same indication.